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Knight ET, Murray Thomson W. A public health perspective on personalized periodontics. Periodontol 2000 2019; 78:195-200. [PMID: 30198135 DOI: 10.1111/prd.12228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
In this paper, we consider personalized periodontics from a public health perspective. Periodontitis is an under-acknowledged and important public health problem, and there has long been interest in identifying and treating those who are at high risk of developing this disease. Although susceptibility/risk-assessment tools in periodontology are currently in their early stages of development, personalized periodontics is increasingly becoming a realistic approach. At the population level, however, personalized periodontics is not an effective way of improving periodontal health because it would target only those who seek help or are able to access care. The occurrence of periodontitis in populations is socially patterned, with those of lower socio-economic position having poorer periodontal health and being far less likely to seek care. There is the potential for social inequalities actually to worsen as a result of personalized periodontics. In most health systems, personalized periodontics is likely to be accessible only to the social strata for whom it is affordable, and those with the greatest need for such an intervention will remain the least likely to be able to get it. Thus, personalized periodontics is likely to be a niche service for a small proportion of the adult population. This is at odds with the public health approach.
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Affiliation(s)
- Ellie T Knight
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sir John Walsh Research Institute, Department of Oral Sciences, School of Dentistry, The University of Otago, Dunedin, New Zealand
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Matsuyama Y, Tsakos G, Listl S, Aida J, Watt R. Impact of Dental Diseases on Quality-Adjusted Life Expectancy in US Adults. J Dent Res 2019; 98:510-516. [DOI: 10.1177/0022034519833353] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Comparing the burden of dental conditions to other health outcomes provides useful insight for public policy. We aimed to estimate quality-adjusted life expectancy (QALE) loss due to dental conditions in the US adult population. Social inequalities in QALE loss by dental conditions were also examined. Data from 3 cross-sectional waves of the National Health and Nutrition Examination Survey (NHANES waves 2001 to 2002, 2003 to 2004, and 2011 to 2012) were pooled and analyzed. The average age of study participants ( n = 9,445) was 48.4 y. Disutility scores were derived from self-rated health and the numbers of physically unhealthy days, mentally unhealthy days, and days with activity limitation, employing a previously published algorithm. The associations between the disutility scores and the numbers of decayed teeth, missing teeth, and periodontitis were examined by multiple linear regression stratified by age groups (20–39, 40–59, and ≥60 y), adjusted for other covariates (age, sex, wave fixed effect, educational attainment, smoking, and diabetes). The QALE loss due to dental conditions at the age of 20 was estimated using life tables. Decayed and missing teeth, but not periodontitis, were associated with a larger disutility score. The coefficient for decayed teeth was larger among the older population, whereas that of missing teeth was smaller among them. The estimated QALE loss was 0.43 y (95% confidence interval [CI], 0.28–0.59), which reached 5.3% of QALE loss (8.15 y; 95% CI, 8.03–8.27) due to overall morbidity. There were clear social gradients in QALE loss by dental conditions across the life course, and people with high school or less education had 0.32 y larger QALE loss in total compared with people with college or more education. This study suggests that improvements in people’s dental health may yield substantial gains in population health and well-being. The necessity of more comprehensive public health strategies is highlighted.
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Affiliation(s)
- Y. Matsuyama
- Department of Global Health Promotion, Tokyo Medical and Dental University (TMDU), Bunkyo-ku, Japan
- Japan Society for the Promotion of Science, Chiyoda-ku, Japan
- Department of Epidemiology and Public Health, University College London, London, UK
| | - G. Tsakos
- Department of Epidemiology and Public Health, University College London, London, UK
| | - S. Listl
- Department of Dentistry-Chair for Quality and Safety of Oral Healthcare, Radboud University Medical Center, Nijmegen, Netherlands
- Department of Conservative Dentistry–Section for Translational Health Economics, Heidelberg University Hospital, Heidelberg, Germany
| | - J. Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, Sendai, Japan
| | - R.G. Watt
- Department of Epidemiology and Public Health, University College London, London, UK
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Ha DH, Do LG. Early Life Professional and Layperson Support Reduce Poor Oral Hygiene Habits in Toddlers-A Prospective Birth Cohort Study. Dent J (Basel) 2018; 6:dj6040056. [PMID: 30297678 PMCID: PMC6313388 DOI: 10.3390/dj6040056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/02/2018] [Accepted: 10/05/2018] [Indexed: 11/16/2022] Open
Abstract
Oral health behaviours of children are formulated from a very young age. Formation of those behaviours among very young children is dependent on their mothers/caregivers who may themselves require support from the health profession or laypersons. The study aimed to investigate if early life visits for check-up and dental advice and perceived support improved oral health behaviours as practiced by mothers of toddlers aged 24–30 months old. Data from a population-base birth cohort study in South Australia was used. The study recruited and followed mothers of newborn children from birth to age 24–30 months. Parental questionnaires collected information about socioeconomic factors, dental visiting patterns, and oral health behaviours as practiced by the mothers for their child. Self-reported putting a child to bed with a bottle and brushing a child’s teeth were the outcome variables. The two main exposures of this study were (1) early visiting for a dental advice, and (2) layperson support that a mother received in the first two years of having the child. Data were analysed progressively from bivariate to multivariable regression models. A total of 1183 mother/child dyads had complete data. The retained sample was representative of the population. Approximately 36% of mothers put their child to bed with a bottle and 26% of mothers did not brush their child’s teeth the night before. Around 29% of children had a visit for dental check-up and 80% of mothers reported having lay support. There were gradients in the outcome variables by socioeconomic factors and the main exposures. Multivariable regression models reported that having no dental visit for advice and having no lay support were associated with 1.30 and 1.21 imes higher rates of putting a child to bed with a bottle, respectively. Having no dental visit for advice was associated with a 1.37-times higher rate of not brushing a child’s teeth, controlling for other factors. This population-based birth cohort study confirmed importance of early life dental visit for check-up and support for mothers of young children in establishing oral health behaviours of young children.
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Affiliation(s)
- Diep Hong Ha
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide 5005, Australia.
| | - Loc Giang Do
- Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide 5005, Australia.
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Brennan DS, Spencer AJ, Roberts-Thomson KF. Socioeconomic and psychosocial associations with oral health impact and general health. Community Dent Oral Epidemiol 2018; 47:32-39. [DOI: 10.1111/cdoe.12419] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 05/23/2018] [Accepted: 08/08/2018] [Indexed: 01/07/2023]
Affiliation(s)
- David S. Brennan
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide South Australia Australia
| | - A. John Spencer
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide South Australia Australia
| | - Kaye F. Roberts-Thomson
- Australian Research Centre for Population Oral Health; The University of Adelaide; Adelaide South Australia Australia
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Kailembo A, Quiñonez C, Lopez Mitnik GV, Weintraub JA, Stewart Williams J, Preet R, Iafolla T, Dye BA. Income and wealth as correlates of socioeconomic disparity in dentist visits among adults aged 20 years and over in the United States, 2011-2014. BMC Oral Health 2018; 18:147. [PMID: 30139349 PMCID: PMC6108097 DOI: 10.1186/s12903-018-0613-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Accepted: 08/13/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies in the United States (US) have used income and education as socioeconomic indicators but there is limited information on other indicators, such as wealth. We aimed to assess how two socioeconomic status measures, income and wealth, compare as correlates of socioeconomic disparity in dentist visits among adults in the US. METHODS Data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014 were used to calculate self-reported dental visit prevalence for adults aged 20 years and over living in the US. Prevalence ratios using Poisson regressions were conducted separately with income and wealth as independent variables. The dependent variable was not having a dentist visit in the past 12 months. Covariates included sociodemographic factors and untreated dental caries. Parsimonious models, including only statistically significant (p < 0.05) covariates, were derived. The Akaike Information Criterion (AIC) measured the relative statistical quality of the income and wealth models. Analyses were additionally stratified by race/ethnicity in response to statistically significant interactions. RESULTS The prevalence of not having a dentist visit in the past 12 months among adults aged 20 years and over was 39%. Prevalence was highest in the poorest (58%) and lowest wealth (57%) groups. In the parsimonious models, adults in the poorest and lowest wealth groups were close to twice as likely to not have a dentist visit (RR 1.69; 95%CI: 1.51-1.90) and (RR 1.68; 95%CI: 1.52-1.85) respectively. In the income model the risk of not having a dentist visit were 16% higher in the age group 20-44 years compared with the 65+ year age group (RR 1.16; 95%CI: 1.04-1.30) but age was not statistically significant in the wealth model. The AIC scores were lower (better) for the income model. After stratifying by race/ethnicity, age remained a significant indicator for dentist visits for non-Hispanic whites, blacks, and Asians whereas age was not associated with dentist visits in the wealth model. CONCLUSIONS Income and wealth are both indicators of socioeconomic disparities in dentist visits in the US, but both do not have the same impact in some populations in the US.
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Affiliation(s)
- Alexander Kailembo
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA.
| | | | - Gabriela V Lopez Mitnik
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | | | - Jennifer Stewart Williams
- Umeå University, Umea, Sweden.,Research Centre for Generational Health and Ageing, University of Newcastle, Callaghan, Australia
| | | | - Timothy Iafolla
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
| | - Bruce A Dye
- National Institutes of Health, National Institute of Dental and Craniofacial Research, Bethesda, USA
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Kailembo A, Preet R, Stewart Williams J. Socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over in China, Ghana, and India. Int J Equity Health 2018; 17:99. [PMID: 29996847 PMCID: PMC6042347 DOI: 10.1186/s12939-018-0812-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 06/27/2018] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND The 2015 Global Burden of Disease Study estimated that oral conditions affect 3.5 billion people worldwide with a higher burden among older adults and those who are socially and economically disadvantaged. Studies of inequalities in the use of oral health services by those in need have been conducted in high-income countries but evidence from low- and middle-income countries (LMICs) is limited. This study measures and describes socioeconomic inequality in self-reported unmet need for oral health services in adults aged 50 years and over, in China, Ghana and India. METHODS A cross-sectional analysis of national survey data from the WHO SAGE Wave 1 (2007-2010) was conducted. Study samples in China (n = 1591), Ghana (n = 425) and India (n = 1307) were conditioned on self-reported need for oral health services in the previous 12 months. The binary dependent variable, unmet need for oral health services, was derived from questions about self-reported need and service use. Prevalence was estimated by country. Unmet need was measured and compared in terms of relative levels of education and household wealth. The methods were logistic regression and the relative index of inequality (RII). Models were adjusted for age, sex, area of residence, marital status, work status and self-rated health. RESULTS The prevalence of unmet need was 60, 80, and 62% in China, Ghana and India respectively. The adjusted RII for education was statistically significant for China (1.5, 95% CI:1.2-1.9), Ghana (1.4, 95% CI: 1.1-1.7), and India (1.5, 95% CI:1.2-2.0), whereas the adjusted RII for wealth was significant only in Ghana (1.3, 95% CI:1.1-1.6). Male sex was significantly associated with self-reported unmet need for oral health services in India. CONCLUSIONS Given rapid population ageing, further evidence of socioeconomic inequalities in unmet need for oral health services by older adults in LMICs is needed to inform policies to mitigate inequalities in the availability of oral health services. Oral health is a universal public health issue requiring attention and action on multiple levels and across the public private divide.
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Affiliation(s)
- Alexander Kailembo
- Oral Health Programme, Non-Communicable Diseases Cluster, World Health Organization, PO Box 9292, Dar Es Salaam, Tanzania
| | - Raman Preet
- Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
| | - Jennifer Stewart Williams
- Umeå International School of Public Health, Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, SE-90185 Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, New Lambton Heights, NSW 2305 Australia
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Chau AMH, Lo ECM, Wong MCM, Chu CH. Interpreting Poisson Regression Models in Dental Caries Studies. Caries Res 2018; 52:339-345. [PMID: 29478049 DOI: 10.1159/000486970] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 01/16/2018] [Indexed: 11/19/2022] Open
Abstract
Oral epidemiology involves studying and investigating the distribution and determinants of dental-related diseases in a specified population group to inform decisions in the management of health problems. In oral epidemiology studies, the hypothesis is typically followed by a cogent study design and data collection. Appropriate statistical analysis is essential to demonstrate the scientific association between the independent factors and the target variable. Analysis also helps to develop and build a statistical model. Poisson regression and its extensions have gained more attention in caries epidemiology than other working models such as logistic regression. This review discusses the fundamental principles and basic knowledge of Poisson regression models. It also introduces the use of a robust variance estimator with a focus on the "robust" interpretation of the model. In addition, extensions of regression models, including the zero-inflated model, hurdle model, and negative binomial model, and their interpretation in caries studies are reviewed. Principles of model fitting, including goodness-of-fit measures, are also discussed. Clinicians and researchers should pay attention to the statistical context of the models used and interpret the models to improve the oral and general health of the communities in which they live.
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Sato Y, Tsuboya T, Watt RG, Aida J, Osaka K. Temporary employment and tooth loss: a cross-sectional study from the J-SHINE study. BMC Oral Health 2018; 18:26. [PMID: 29466974 PMCID: PMC5822609 DOI: 10.1186/s12903-018-0488-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 02/14/2018] [Indexed: 12/17/2022] Open
Abstract
Background Temporary employment leads to psychological distress and higher mortality, but data on its associations with oral health is limited. We examined whether having the experience of temporary employment was associated with tooth loss among working adults in Japan. Methods We conducted a cross-sectional study from the 2010–2011 Japanese Study on Stratification, Health, Income, and Neighborhood study that analyzed 2652 participants aged 25–50 years (men = 1394; women = 1258). Independent variable was changes in employment status (continuous regular employment and the experience of temporary employment). Dependent variable was self-reported tooth loss (none, 1 tooth, 2 teeth, 3 teeth, 4 teeth, and more than 4 teeth). Covariates were sex, age, years of education, self-rated household economic status in early life at 5 years old, marital status, number of family members in the household, history of diabetes, and body mass index. We conducted a negative binomial regression analysis to estimate prevalence rate ratios (PRRs) and 95% confidence intervals (95%CIs) for tooth loss. We also confirmed the interaction term between changes in employment status and sex. Results The median age of the participants was 37 years. The percentages of men and women who experienced temporary employment were 14.5% and 61.3%, respectively. Compared with continuous regular employment, the experience of temporary employment was significantly associated with tooth loss in both sexes after adjusting for the covariates (men: PRR = 1.50 [95%CI = 1.13, 2.00]; women: PRR = 1.42 [95%CI = 1.14, 1.76]). The interaction term between employment status and sex was not significant (p = 0.71). Conclusions Temporary employment is adversely associated with oral health.
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Affiliation(s)
- Yukihiro Sato
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Toru Tsuboya
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan.
| | - Richard G Watt
- Department of Epidemiology and Public Health, University College London, Gower Street, London, WC1E 6BT, UK
| | - Jun Aida
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
| | - Ken Osaka
- Department of International and Community Oral Health, Tohoku University Graduate School of Dentistry, 4-1, Seiryo-machi, Aoba-ku, Sendai, Miyagi, Japan
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Kaewkamnerdpong I, Krisdapong S. The Associations of School Oral Health-Related Environments with Oral Health Behaviours and Dental Caries in Children. Caries Res 2018; 52:166-175. [DOI: 10.1159/000485747] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 11/20/2017] [Indexed: 11/19/2022] Open
Abstract
Creating supportive oral health-related environments in schools is an important strategy for promoting schoolchildren’s oral health. This study determined the associations between school environments and children’s oral behaviour and dental caries. The data on school oral health-related environments were obtained through observation and interviews. Oral behaviour and dental caries data were collected through interviews and oral examinations of 984 sixth grade children. χ2 and multiple logistic regression, adjusted for sociodemographic and economic status, other school environment variables, and oral behaviour were used. Providing fresh fruit with school meals was associated with low sweets consumption and low caries levels. Children’s daily sweets consumption was positively associated with sweetened milk sales in schools. Selling sweetened beverages, including sweetened milk, sweetened drinks, and soft drinks, was associated with high caries levels, while selling meat and crispy packed snacks was associated with low caries levels. Children in schools with integrated oral health education were significantly more likely to brush their teeth twice a day and to brush after lunch. In conclusion, school oral health-related environments, especially available food choices, were associated with sweets consumption behaviour and caries levels. Children in schools with integrated oral health education had better brushing habits.
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Do L, Ha D, Roberts-Thomson K, Jamieson L, Peres M, Spencer A. Race- and Income-Related Inequalities in Oral Health in Australian Children by Fluoridation Status. JDR Clin Trans Res 2018; 3:170-179. [DOI: 10.1177/2380084417751350] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- L.G. Do
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - D.H. Ha
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - K.F. Roberts-Thomson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - L. Jamieson
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - M.A. Peres
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
| | - A.J. Spencer
- The Australian Research Centre for Population Oral Health, Adelaide Dental School, The University of Adelaide, Adelaide, South Australia, Australia
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Reda SF, Reda SM, Thomson WM, Schwendicke F. Inequality in Utilization of Dental Services: A Systematic Review and Meta-analysis. Am J Public Health 2017; 108:e1-e7. [PMID: 29267052 DOI: 10.2105/ajph.2017.304180] [Citation(s) in RCA: 121] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Dental diseases are among the most prevalent conditions worldwide, with universal access to dental care being one key to tackling them. Systematic quantification of inequalities in dental service utilization is needed to identify where these are most pronounced, assess factors underlying the inequalities, and evaluate changes in inequalities with time. OBJECTIVES To evaluate the presence and extent of inequalities in dental services utilization. SEARCH METHODS We performed a systematic review and meta-analysis by searching 3 electronic databases (MEDLINE, Embase, Cochrane Central Database), covering the period from January 2005 to April 2017. SELECTION CRITERIA We included observational studies investigating the association between regular dental service utilization and sex, ethnicity, place of living, educational or income or occupational position, or insurance coverage status. Two reviewers undertook independent screening of studies and made decisions by consensus. DATA COLLECTION AND ANALYSIS Our primary outcome was the presence and extent of inequalities in dental service utilization, measured as relative estimates (usually odds ratios [ORs]) comparing different (high and low utilization) groups. We performed random effects meta-analysis and subgroup analyses by region, and we used meta-regression to assess whether and how associations changed with time. MAIN RESULTS A total of 117 studies met the inclusion criteria. On the basis of 7 830 810 participants, dental services utilization was lower in male than female participants (OR = 0.85; 95% confidence interval [CI] = 0.74, 0.95; P < .001); ethnic minorities or immigrants than ethnic majorities or natives (OR = 0.71; 95% CI = 0.59, 0.82; P < .001); those living in rural than those living in urban places (OR = 0.87; 95% CI = 0.76, 0.97; P = .011); those with lower than higher educational position (OR = 0.61; 95% CI = 0.55, 0.68; P < .001) or income (OR = 0.66; 95% CI = 0.54, 0.79; P < .001); and among those without insurance coverage status than those with such status (OR = 0.58; 95% CI = 0.49, 0.68; P < .001). Occupational status (OR = 0.95; 95% CI = 0.81, 1.09; P = .356) had no significant impact on utilization. The observed inequalities did not significantly change over the assessed 12-year period and were universally present. AUTHORS' CONCLUSIONS Inequalities in dental service utilization are both considerable and globally consistent. Public Health Implications. The observed inequalities in dental services utilization can be assumed to significantly cause or aggravate existing dental health inequalities. Policymakers should address the physical, socioeconomic, or psychological causes underlying the inequalities in utilization.
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Affiliation(s)
- Sophie F Reda
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Seif M Reda
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - W Murray Thomson
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
| | - Falk Schwendicke
- Sophie F. Reda, Seif M. Reda, and Falk Schwendicke are with Department of Operative and Preventive Dentistry, Charité-Universitätsmedizin, Berlin, Germany. W. Murray Thomson is with the Sir John Walsh Research Institute, Faculty of Dentistry, The University of Otago, Dunedin, New Zealand
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Valente MIB, Vettore MV. Contextual and individual determinants of periodontal disease: Multilevel analysis based on Andersen's model. Community Dent Oral Epidemiol 2017; 46:161-168. [DOI: 10.1111/cdoe.12349] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2017] [Accepted: 10/03/2017] [Indexed: 11/26/2022]
Affiliation(s)
- Maria I. B. Valente
- Unit of Dental Public Health; School of Clinical Dentistry; University of Sheffield; Sheffield UK
- Department of Specific Formation; School of Dentistry; Fluminense Federal University; Nova Friburgo RJ Brazil
| | - Mario V. Vettore
- Unit of Dental Public Health; School of Clinical Dentistry; University of Sheffield; Sheffield UK
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Dimba E, Yengopal V, Joshua E, Thavarajah R, Balasundaram S. Access and management of HIV-related diseases in resource-constrained settings: a workshop report. Oral Dis 2017; 22 Suppl 1:206-10. [PMID: 27109288 DOI: 10.1111/odi.12424] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
With advancement of medical interventions, the lifespan of people living with HIV has increased globally. However, low- and middle-income countries (LMICs) which bear the greatest burden of the HIV pandemic face a constant challenge in addressing the treatment needs of immune-suppressed patients. An analysis of the current management protocols and access to medication in resource-poor settings was conducted at this workshop, with emphasis on the situation in resource-poor settings. The participants developed a consensus document based on the need to respond to the constantly changing HIV pandemic. Provision of oral health care must be guided by interconnecting principles based on population based strategies that address upstream determinants of health. Basic oral health coverage in developing countries can only be realized with a strong foundation at the primary health level. Early diagnosis of HIV-related comorbidities including the adverse effects of ARVs is essential for the improvement of treatment outcomes. Standardization of oral health care delivery mechanisms will facilitate evaluation at national and regional levels. Oral health care workers have a moral obligation to participate in sustained campaigns to reduce the social stigma associated with HIV/AIDS in their work places at every stage of the referral chain. Future research also needs to realign itself towards prevention using the common risk factor approach, which has a broader impact on non-communicable diseases, which are increasingly affecting patients with HIV/AIDS as their life expectancies increase.
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Affiliation(s)
- Eao Dimba
- School of Dental Sciences, University of Nairobi, Nairobi, Kenya
| | - V Yengopal
- Division of Public Oral Health, University of the Witwatersrand, Johannesburg, South Africa
| | - E Joshua
- Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - R Thavarajah
- Ragas Dental College and Hospital, Chennai, Tamil Nadu, India
| | - S Balasundaram
- Departments of Oral Pathology, Chennai Dental Research Foundation, Chennai, Tamil Nadu, India
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Oral health literacy and oral health outcomes in an adult population in Brazil. BMC Public Health 2017; 18:60. [PMID: 28747157 PMCID: PMC5530456 DOI: 10.1186/s12889-017-4443-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Accepted: 05/15/2017] [Indexed: 12/01/2022] Open
Abstract
Background To investigate the association between critical and communicative oral health literacy (OHL) and oral health outcomes (status, oral health-related quality of life and practices) in adults. Methods This cross-sectional study examined a household probability sample of 248 adults, representing 149,635 residents (20–64 years old) in Piracicaba-SP, Brazil. Clinical oral health and socioeconomic and demographic data, as well as data on oral health-related quality of life (OHIP-14) and health practices were collected. The oral examinations were carried out in the participants’ homes, using the World Health Organization criteria for oral diseases. The critical and communicative OHL instrument was the primary independent variable, and it was measured using five Likert items that were dichotomized as ‘high’ (‘agree’ and ‘strongly agree’ responses for the 5 items) and ‘low’ OHL. Binary and multinomial logistic regressions were performed on each outcome (oral health status and practices), controlling for age, sex and socioeconomic status (SES). Results Approximately 71.5% presented low OHL. When adjusted for age and sex (first model) low OHL was associated with untreated caries (Odds Ratio = 1.92, 95% Confidence Interval = 1.07–3.45), tooth brushing <3 times a day (OR = 2.00, 1.11–3.62) and irregular tooth flossing (OR = 2.17, 1.24–3.80). After SES inclusion in the first model, significant associations were found for low OHL when the outcomes were: presence of biofilm (OR = 1.83, 1.08–3.33), dental care for emergency only (OR = 2.24, 1.24–4.04) and prevalence of oral health impact on quality of life (OR = 2.06, 1.15–3.69). Conclusion Adjusting for age, sex and SES, OHL is related to a risk factor (biofilm) and a consequence of poor oral health (emergency dental visits) and can interfere with the impact of oral diseases on quality of life. As low OHL can be modified, the results support oral health promotion strategies directed at improving critical and communicative oral health literacy in adult populations.
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Braun PA, Widmer-Racich K, Sevick C, Starzyk EJ, Mauritson K, Hambidge SJ. Effectiveness on Early Childhood Caries of an Oral Health Promotion Program for Medical Providers. Am J Public Health 2017; 107:S97-S103. [PMID: 28661802 DOI: 10.2105/ajph.2017.303817] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess an oral health promotion (OHP) intervention for medical providers' impact on early childhood caries (ECC). METHODS We implemented a quasiexperimental OHP intervention in 8 federally qualified health centers that trained medical providers on ECC risk assessment, oral examination and instruction, dental referral, and fluoride varnish applications (FVAs). We measured OHP delivery by FVA count at medical visits. We measured the intervention's impact on ECC in 3 unique cohorts of children aged 3 to 4 years in 2009 (preintervention; n = 202), 2011 (midintervention; n = 420), and 2015 (≥ 4 FVAs; n = 153). We compared numbers of decayed, missing, and filled tooth surfaces using adjusted zero-inflated negative binomial models. RESULTS Across 3 unique cohorts, the FVA mean (range) count was 0.0 (0), 1.1 (0-7), and 4.5 (4-7) in 2009, 2011, and 2015, respectively. In adjusted zero-inflated negative binomial models analyses, children in the 2015 cohort had significantly fewer decayed, missing, and filled tooth surfaces than did children in previous cohorts. CONCLUSIONS An OHP intervention targeting medical providers reduced ECC when children received 4 or more FVAs at a medical visit by age 3 years.
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Affiliation(s)
- Patricia A Braun
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katina Widmer-Racich
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Carter Sevick
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Erin J Starzyk
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Katya Mauritson
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
| | - Simon J Hambidge
- Patricia A. Braun, Katina Widmer-Racich, and Carter Sevick are with the Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado Anschutz School of Medicine, Aurora. Erin J. Starzyk and Katya Mauritson are with the Colorado Department of Public Health and Environment, Denver. Patricia A. Braun is also with and Simon J. Hambidge is with Denver Health and Hospital, Denver, CO
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Kengne Talla P, Gagnon MP, Dupéré S, Bedos C, Légaré F, Dawson AB. Interventions for increasing health promotion practices in dental healthcare settings. Hippokratia 2017. [DOI: 10.1002/14651858.cd010955.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Pascaline Kengne Talla
- Centre de Recherche du CHU de Québec (CRCHUQ) - Hôpital St-François d'Assise; 10 Rue de l'Espinay, D6-727 Québec QC Canada G1L 3L5
| | - Marie-Pierre Gagnon
- CHU de Québec - Université Laval Research Centre; Population Health and Optimal Health Practices Research Unit; 10 Rue de l'Espinay, D6-727 Québec City QC Canada G1L 3L5
- Université Laval; Faculté des Sciences Infirmières; 1050 Rue de la Médecine, Pavillon Ferdinand-Vandry, CIFSS Québec City QC Canada G1V 0A6
| | - Sophie Dupéré
- Université Laval; Faculté des Sciences Infirmières; 1050 Rue de la Médecine, Pavillon Ferdinand-Vandry, CIFSS Québec QC Canada G1V 0A6
| | - Christophe Bedos
- McGill University; Faculty of Dentistry; 3550 University St. Montreal QC Canada H3A 2A7
| | - France Légaré
- CHU de Québec - Université Laval Research Centre; Population Health and Optimal Health Practices Research Unit; 10 Rue de l'Espinay, D6-727 Québec City QC Canada G1L 3L5
- Université Laval; Department of Family Medicine and Emergency Medicine; Québec City QC Canada
| | - Aimée B Dawson
- Université Laval; Faculté de Médecine Dentaire; 2420 Rue de la Terrasse Québec QC Canada G1V 0A6
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Brown LF, Ford PJ, Symons AL. Periodontal disease and the special needs patient. Periodontol 2000 2017; 74:182-193. [DOI: 10.1111/prd.12198] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2016] [Indexed: 12/22/2022]
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Ivanoff CS, Yaneva K, Luan D, Andonov B, Kumar RR, Agnihotry A, Ivanoff AE, Emmanouil D, Volpato LER, Koneski F, Muratovska I, Al-Shehri HA, Al-Taweel SM, Daly M. A global probe into dental student perceptions about philanthropy, global dentistry and international student exchanges. Int Dent J 2017; 67:107-116. [DOI: 10.1111/idj.12260] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Arrica M, Carta G, Cocco F, Cagetti MG, Campus G, Ierardo G, Ottolenghi L, Sale S, Strohmenger L. Does a social/behavioural gradient in dental health exist among adults? A cross-sectional study. J Int Med Res 2017; 45:451-461. [PMID: 28345424 PMCID: PMC5536683 DOI: 10.1177/0300060516675682] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To explore the potential presence of a social/behavioural gradient in dental health among Italian adults using a cross-sectional study. Methods Caries indices were recorded among 480 subjects (52.9% men, 47.1% women) who also completed a structured self-administered social and behavioural questionnaire. A social/behavioural gradient was generated as the sum of the worst circumstances recorded on the questionnaire (cariogenic diet, smoking, lowest occupational profile, brushing teeth < twice daily, lowest educational level, uneven dental examination attendance). Results Caries figures (DMFT) and the number of filled sound teeth (FS-T) were statistically significantly linked to the social/behavioural gradient (DMFT: χ2(9) = 20.17 p = 0.02, Z = 0.02 p = 0.99; FS-T: χ2(9) = 25.68 p < 0.01, Z = −4.31 p < 0.01). DMFT was statistically significantly associated with gender and with social and behavioural variables. FS-T was higher in women (p = 0.03) and was linked to smoking (p < 0.01). Conclusions The proposed social/behavioural gradient demonstrated how subjects reporting the worst circumstances on the questionnaire exhibited the worst dental health. The use of the gradient demonstrates that health promotion and prevention cannot be compartmentalized.
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Affiliation(s)
- Mariantonietta Arrica
- 1 Depertment of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Giovanna Carta
- 1 Depertment of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Fabio Cocco
- 1 Depertment of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.,2 World Health Organization, Collaborating Centre for Epidemiology and Preventive Dentistry, Milan, Italy
| | - Maria Grazia Cagetti
- 2 World Health Organization, Collaborating Centre for Epidemiology and Preventive Dentistry, Milan, Italy.,3 Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Lombardia, Italy
| | - Guglielmo Campus
- 1 Depertment of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy.,2 World Health Organization, Collaborating Centre for Epidemiology and Preventive Dentistry, Milan, Italy
| | - Gaetano Ierardo
- 4 Department of Oral and Maxillo Facial Sciences, University of Rome La Sapienza, Rome, Lazio, Italy
| | - Livia Ottolenghi
- 4 Department of Oral and Maxillo Facial Sciences, University of Rome La Sapienza, Rome, Lazio, Italy
| | - Silvana Sale
- 1 Depertment of Surgical, Microsurgical and Medical Sciences, University of Sassari, Sassari, Italy
| | - Laura Strohmenger
- 2 World Health Organization, Collaborating Centre for Epidemiology and Preventive Dentistry, Milan, Italy.,3 Department of Biomedical, Surgical and Dental Sciences, University of Milan, Milan, Lombardia, Italy
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Naidoo S, Dimba E, Yengopal V, Folayan MO, Akpata ES. Strategies for Oral Health Research in Africa and the Middle Eastern Region. Adv Dent Res 2017; 27:43-9. [PMID: 26101339 DOI: 10.1177/0022034515575539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The highest burden of diseases worldwide is in low- and middle-income countries, but due to lack of capacity and inadequate infrastructure, research output from these countries is unable to address existing and emerging challenges in health care. Oral health research has particularly been hampered by low prioritization, resulting in insufficient development of this sector. There is an urgent need for research correlating oral health to upstream social and environmental determinants and promoting the common risk factor approach for prevention of noncommunicable diseases. Population-wide preventive measures for oral health care are more effective than purely curative approaches, especially for vulnerable groups who have limited access to information and appropriate health care. This article identifies priorities and proposes strategies for researchers, stakeholders, and policy makers for the initiation and sustenance of appropriate oral health care research. The proposed interventions are intended to promote collaboration, capacity building, and health advocacy. Local ownership in multinational research projects in low- and middle-income countries, complemented by skills transfer from high-income countries, is encouraged to ensure that regional health needs are addressed. Emphasis is placed on a shift toward translational research that has a direct impact on oral health care systems.
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Affiliation(s)
- S Naidoo
- Faculty of Dentistry, University of the Western Cape, Cape Town, South Africa
| | - E Dimba
- School of Dental Science, University of Nairobi, Nairobi, Kenya
| | - V Yengopal
- School of Oral Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - M O Folayan
- Faculty of Dentistry, Obafemi Awolowa University, Ile-Ife, Nigeria
| | - E S Akpata
- College of Medicine, Lagos State University, Lagos, Nigeria
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71
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Chidzonga MM, Carneiro LC, Kalyanyama BM, Kwamin F, Oginni FO. Determinants of Oral Diseases in the African and Middle East Region. Adv Dent Res 2017; 27:26-31. [PMID: 26101337 DOI: 10.1177/0022034515581645] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Oral health policies must be developed that emphasize the role of social determinants in health and oral diseases. The aim of this report is to review literature on determinants of oral diseases and apply the concepts to promoting oral health in the African countries in the African and Middle East region (AMER). Structural and proximal determinants of oral diseases are common to those affected by other noncommunicable diseases (NCDs). Oral diseases are also heavily affected by issues of politics, poor health behaviors, underdeveloped health systems, and low oral health literacy. Wide-scale poverty exists in populations in the AMER. Oral health promotion and preventive oral health programs should therefore be integrated with those for general health and use the common risk factor approach (CRFA). Attempts should be made to improve the daily living conditions and reduce the incline of the social gradient. Oral health practitioners should use the CRFA when dealing with determinants of oral diseases and in the design of preventive oral health programs. The detrimental effects of the social determinants of health may be ameliorated by involving both the individual and community. Interventions in health promotion programs in the AMER need more research on the epidemiology of oral diseases and the role played by the social determinants of oral diseases, especially with regard to poverty. The high levels of poverty and low gross domestic product in most countries in the African region make it difficult to fund high-quality, affordable, accessible oral health services.
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Affiliation(s)
- M M Chidzonga
- Department of Dentistry, University of Zimbabwe, College of Health Sciences, Harare, Zimbabwe
| | - L C Carneiro
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - B M Kalyanyama
- School of Dentistry, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - F Kwamin
- Deparment of Oral Medicine and Oral Pathology, University of Ghana, Dental School, Korle-Bu, Accra, Ghana
| | - F O Oginni
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria
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Jepsen S, Blanco J, Buchalla W, Carvalho JC, Dietrich T, Dörfer C, Eaton KA, Figuero E, Frencken JE, Graziani F, Higham SM, Kocher T, Maltz M, Ortiz-Vigon A, Schmoeckel J, Sculean A, Tenuta LM, van der Veen MH, Machiulskiene V. Prevention and control of dental caries and periodontal diseases at individual and population level: consensus report of group 3 of joint EFP/ORCA workshop on the boundaries between caries and periodontal diseases. J Clin Periodontol 2017; 44 Suppl 18:S85-S93. [DOI: 10.1111/jcpe.12687] [Citation(s) in RCA: 179] [Impact Index Per Article: 25.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 12/20/2022]
Affiliation(s)
- Søren Jepsen
- Department of Periodontology; Operative & Preventive Dentistry; University of Bonn; Bonn Germany
| | - Juan Blanco
- Department of Stomatology; University of Santiago de Compostela; Santiago de Compostela Spain
| | - Wolfgang Buchalla
- Department for Conservative Dentistry and Periodontology; University Medical Center Regensburg; Regensburg Germany
| | - Joana C. Carvalho
- Faculty of Medicine and Dentistry; Catholic University of Louvain; Brussels Belgium
| | - Thomas Dietrich
- The School of Dentistry; University of Birmingham; Birmingham UK
| | - Christof Dörfer
- Clinic for Conservative Dentistry and Periodontology; Christian-Albrechts-University Kiel; Kiel Germany
| | | | - Elena Figuero
- Periodontology; University Complutense; Madrid Spain
| | - Jo E. Frencken
- Radboud University Medical Center; Nijmegen The Netherlands
| | - Filippo Graziani
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | - Susan M. Higham
- Department of Health Services Research & School of Dentistry; University of Liverpool; Liverpool UK
| | - Thomas Kocher
- Unit of Periodontology; University Medicine; Ernst-Moritz-Arndt-University Greifswald; Greifswald Germany
| | - Marisa Maltz
- Department of Preventive and Social Dentistry; Federal University of Rio Grande do Sul; Porto Alegre Brazil
| | | | - Julian Schmoeckel
- Department of Preventive & Pediatric Dentistry; University of Greifswald; Greifswald Germany
| | - Anton Sculean
- Department of Periodontology; School of Dental Medicine; University of Bern; Bern Switzerland
| | - Livia M.A. Tenuta
- Piracicaba Dental School; University of Campinas (UNICAMP); Piraciaba Brazil
| | - Monique H. van der Veen
- Department of Preventive Dentistry; Academic Centre for Dentistry Amsterdam; University of Amsterdam and VU University; Amsterdam The Netherlands
- Oral Hygiene School; Hogeschool Inholland; Amsterdam The Netherlands
| | - Vita Machiulskiene
- Clinic of Dental and Oral Pathology; Lithuanian University of Health Sciences; Kaunas Lithuania
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Bergeron DA, Talbot LR, Gaboury I. Realist evaluation of intersectoral oral health promotion interventions for schoolchildren living in rural Andean communities: a research protocol. BMJ Open 2017; 7:e014531. [PMID: 28237962 PMCID: PMC5337730 DOI: 10.1136/bmjopen-2016-014531] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2016] [Revised: 12/20/2016] [Accepted: 01/25/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Intersectoral collaboration, known to promote more sustainable change within communities, will be examined in an oral health promotion program (OHPP). In Peru, an OHPP was implemented by the Ministry of Health, to reduce the incidence of caries in schoolchildren. In rural Andean communities, however, these initiatives achieved limited success. The objectives of this project are: (1) to understand the context and the underlying mechanisms associated with Peruvian OHPP's current effects among school children living in rural Andean communities and (2) to validate a theory explaining how and under which circumstances OHP intersectoral interventions on schoolchildren living in rural Andean communities produce their effects. METHODS AND ANALYSIS Through a realist evaluation, the context, underlying mechanisms and programme outcomes will be identified. This process will involve five different steps. In the first and second steps, a logic model and an initial theory are developed. In the third step, data collection will permit measurement of the OHHP's outcomes with quantitative data, and exploration of the elements of context and the mechanisms with qualitative data. In the fourth and fifth steps, iterative data analysis and a validation process will allow the identification of Context-Mechanism-Outcome configuration, and validate or refine the initial theory. ETHICS AND DISSEMINATION This research project has received approval from the Comité d'éthique de la recherche en santé chez l'humain du Centre hospitalier universitaire de Sherbrooke. The initial theory and research results will be published in relevant journals in public health and oral health. They will also be presented at realist evaluation and health promotion international conferences.
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Affiliation(s)
- Dave A Bergeron
- Department of Health Research Programs, Faculty of Medicine and Health Sciences,Université de Sherbrooke, Longueuil, Québec, Canada
- Department of Nursing, Université du Québec à Rimouski, Rimouski, Québec, Canada
| | - Lise R Talbot
- School of Nursing, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences,Université de Sherbrooke, Longueuil, Québec, Canada
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Chaffee BW, Rodrigues PH, Kramer PF, Vítolo MR, Feldens CA. Oral health-related quality-of-life scores differ by socioeconomic status and caries experience. Community Dent Oral Epidemiol 2017; 45:216-224. [PMID: 28083880 DOI: 10.1111/cdoe.12279] [Citation(s) in RCA: 115] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/28/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVES (i) Quantify the relative association between child dental caries experience and maternal-reported child oral health-related quality of life (OHRQoL); (ii) examine whether that association differed according to family socioeconomic status (SES); and (iii) explore whether absolute OHRQoL varied by family SES at similar levels of child caries experience. METHODS This study was a cross-sectional analysis of children in southern Brazil (n=456, mean age: 38 months) participating in an existing health centre-based intervention study. OHRQoL impact was quantified as mean score on the Brazilian Early Childhood Oral Health Impact Scale (ECOHIS) and compared over categories of caries experience (dmft: 0, dmft: 1-4, dmft: ≥5). Adjusted ECOHIS ratios between caries categories were calculated using regression modelling, overall and within socioeconomic strata defined by maternal education, social class and household income. RESULTS Caries prevalence (dmft >0) was 39.7%, mean ECOHIS score was 2.0 (SD: 3.5), and 44.3% of mothers reported OHRQoL impact (ECOHIS score >0). Increasing child caries experience was associated with worsening child and family quality of life: ECOHIS scores were 3.0 times greater (95% CI: 2.0, 4.4) for children with dmft ≥5 vs dmft=0, a pattern that persisted regardless of family socioeconomic status (P for interaction: all >0.3). However, adjusted for dental status and sociodemographic characteristics, mean ECOHIS scores were lower when reported by mothers of less educational attainment (ratio: 0.7; 95% CI: 0.5, 1.0), lower social class (ratio: 0.7; 95% CI: 0.5, 1.0) or in lower income households (ratio: 0.8; 95% CI: 0.6, 1.3). CONCLUSION Dental caries was associated with negative child and family experiences and lower OHRQoL across all social groups; yet, families facing greater disadvantage may report lesser quality-of-life impact at the same level of disease experience. Thus, subjective quality-of-life measures may differ under varying social contexts, with possible implications for service utilization, evaluating oral health interventions, or quantifying disease morbidity in low-SES groups.
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Affiliation(s)
- Benjamin W Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, CA, USA
| | | | | | - Márcia Regina Vítolo
- Department of Nutrition, Universidade Federal de Ciências da Saúde de Porto Alegre, Porto Alegre, Brazil
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Knevel R, Gussy MG, Farmer J. Exploratory scoping of the literature on factors that influence oral health workforce planning and management in developing countries. Int J Dent Hyg 2016; 15:95-105. [PMID: 27943545 DOI: 10.1111/idh.12260] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/25/2016] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The purpose of this study was to scope the literature that exists about factors influencing oral health workforce planning and management in developing countries (DCs). METHODS The Arksey and O'Malley method for conducting a scoping review was used. A replicable search strategy was applied, using three databases. Factors influencing oral health workforce planning and management in DCs identified in the eligible articles were charted. FINDINGS Four thousand citations were identified; 41 papers were included for review. Most included papers were situational analyses. Factors identified were as follows: lack of data, focus on the restorative rather than preventive care in practitioner education, recent increase in number of dental schools (mostly private) and dentistry students, privatization of dental care services which has little impact on care maldistribution, and debates about skill mix and scope of practice. Oral health workforce management in the eligible studies has a bias towards dentist-led systems. Due to a lack of country-specific oral health related data in developing or least developed countries (LDCs), oral health workforce planning often relies on data and modelling from other countries. DISCUSSION AND CONCLUSION Approaches to oral health workforce management and planning in developing or LDCs are often characterized by approaches to increase numbers of dentists, thus not ameliorating maldistribution of service accessibility. Governments appear to be reducing support for public and preventative oral healthcare, favouring growth in privatized dental services. Changes to professional education are necessary to trigger a paradigm shift to the preventive approach and to improve relationships between different oral healthcare provider roles. This needs to be premised on greater appreciation of preventive care in health systems and funding models.
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Affiliation(s)
- Rjm Knevel
- Department of Dentistry and Oral Health, College of Science, Health & Engineering, La Trobe University, Bendigo, Vic., Australia
| | - M G Gussy
- La Trobe University, Bendigo, Vic., Australia
| | - J Farmer
- Centre for Social Impact, Swinburne University, Sydney, NSW, Australia
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Heilbrunn-Lang AY, Carpenter LM, Powell SM, Kearney SL, Cole D, de Silva AM. Reviewing public policy for promoting population oral health in Victoria, Australia (2007-12). AUST HEALTH REV 2016. [PMID: 26210775 DOI: 10.1071/ah15013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Government policy and planning set the direction for community decisions related to resource allocation, infrastructure, services, programs, workforce and social environments. The aim ofthe present study was to examine the policy and planning context for oral health promotion in Victoria, Australia, over the period 2007-12. METHODS Key Victorian policies and plans related to oral health promotion in place during the 2007-12 planning cycle were identified through online searching, and content analysis was performed. Inclusion of oral health (and oral health-related) promotion initiatives was assessed within the goals, objectives and strategies sections of each plan. RESULTS Six of the 223 public health plans analysed (3%) included oral health 'goals' (including one plan representing nine agencies). Oral health was an 'objective' in 10 documents. Fifty-six plan objectives, and 70 plan strategies related to oral health or healthy eating for young children. Oral health was included in municipal plans (44%) more frequently than the other plans examined. CONCLUSION There is a policy opportunity to address oral health at a community level, and to implement population approaches aligned with the Ottawa Charter that address the social determinants of health.
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Affiliation(s)
| | - Lauren M Carpenter
- University of Melbourne, Centre for Health Equity, The Melbourne School of Population and Global Health, Level 4, 207 Bouverie Street, Carlton, Vic. 3053, Australia. Email
| | - Seona M Powell
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia. ;
| | - Susan L Kearney
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia. ;
| | - Deborah Cole
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia. ;
| | - Andrea M de Silva
- Dental Health Services Victoria, 720 Swanston Street, Carlton, Vic. 3053, Australia. ;
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Kailembo A, Preet R, Stewart Williams J. Common risk factors and edentulism in adults, aged 50 years and over, in China, Ghana, India and South Africa: results from the WHO Study on global AGEing and adult health (SAGE). BMC Oral Health 2016; 17:29. [PMID: 27465011 PMCID: PMC4964081 DOI: 10.1186/s12903-016-0256-2] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2016] [Accepted: 07/15/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Edentulism (loss of all teeth) is a final marker of disease burden for oral health common among older adults and poorer populations. Yet most evidence is from high-income countries. Oral health has many of the same social and behavioural risk factors as other non-communicable diseases (NCDs) which are increasing rapidly in low- and middle-income countries with ageing populations. The "common risk factor approach" (CRFA) for oral health addresses risk factors shared with NCDs within the broader social and economic environment. METHODS The aim is to improve understanding of edentulism prevalence, and association between common risk factors and edentulism in adults aged 50 years and above using nationally representative samples from China (N = 11,692), Ghana (N = 4093), India (N = 6409) and South Africa (N = 2985). The data source is the World Health Organization (WHO) Study on global AGEing and adult health (SAGE) Wave 1 (2007-2010). Multivariable logistic regression describes association between edentulism and common risk factors reported in the literature. RESULTS Prevalence of edentulism: in China 8.9 %, Ghana 2.9 %, India 15.3 %, and South Africa 8.7 %. Multivariable analysis: in China, rural residents were more likely to be edentulous (OR 1.36; 95 % CI 1.09-1.69) but less likely to be edentulous in Ghana (OR 0.53; 95 % CI 0.31-0.91) and South Africa (OR 0.52; 95 % CI 0.30-0.90). Respondents with university education (OR 0.31; 95 % CI 0.18-0.53) and in the highest wealth quintile (OR 0.68; 95 % CI 0.52-0.90) in China were less likely to be edentulous. In South Africa respondents with secondary education were more likely to be edentulous (OR 2.82; 95 % CI 1.52-5.21) as were those in the highest wealth quintile (OR 2.78; 95 % CI 1.16-6.70). Edentulism was associated with former smokers in China (OR 1.57; 95 % CI 1.10-2.25) non-drinkers in India (OR 1.65; 95 % CI 1.11-2.46), angina in Ghana (OR 2.86; 95 % CI 1.19-6.84) and hypertension in South Africa (OR 2.75; 95 % CI 1.72-4.38). Edentulism was less likely in respondents with adequate nutrition in China (OR 0.68; 95 % CI 0.53-0.87). Adjusting for all other factors, compared with China, respondents in India were 50 % more likely to be edentulous. CONCLUSIONS Strengthening the CRFA should include addressing common determinants of health to reduce health inequalities and improve both oral and overall health.
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Affiliation(s)
- Alexander Kailembo
- Elite Dental Clinic, 6th Floor, Oasis Office Complex, Plot No. 14/15, Haile Selassie Road, P.O Box 38394, Masaki, Dar es salaam Tanzania
| | - Raman Preet
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
| | - Jennifer Stewart Williams
- Unit of Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Faculty of Medicine, Umeå University, Umeå, Sweden
- Research Centre for Generational Health and Ageing, Faculty of Health, University of Newcastle, Newcastle, Australia
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Braun PA, Quissell DO, Henderson WG, Bryant LL, Gregorich SE, George C, Toledo N, Cudeii D, Smith V, Johs N, Cheng J, Rasmussen M, Cheng NF, Santo W, Batliner T, Wilson A, Brega A, Roan R, Lind K, Tiwari T, Shain S, Schaffer G, Harper M, Manson SM, Albino J. A Cluster-Randomized, Community-Based, Tribally Delivered Oral Health Promotion Trial in Navajo Head Start Children. J Dent Res 2016; 95:1237-44. [PMID: 27439724 DOI: 10.1177/0022034516658612] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The authors tested the effectiveness of a community-based, tribally delivered oral health promotion (OHP) intervention (INT) at reducing caries increment in Navajo children attending Head Start. In a 3-y cluster-randomized trial, we developed an OHP INT with Navajo input that was delivered by trained Navajo lay health workers to children attending 52 Navajo Head Start classrooms (26 INT, 26 usual care [UC]). The INT was designed as a highly personalized set of oral health-focused interactions (5 for children and 4 for parents), along with 4 fluoride varnish applications delivered in Head Start during academic years of 2011 to 2012 and 2012 to 2013. The authors evaluated INT impact on decayed, missing, and filled tooth surfaces (dmfs) increment compared with UC. Other outcomes included caries prevalence and caregiver oral health-related knowledge and behaviors. Modified intention-to-treat and per-protocol analyses were conducted. The authors enrolled 1,016 caregiver-child dyads. Baseline mean dmfs/caries prevalence equaled 19.9/86.5% for the INT group and 22.8/90.1% for the UC group, respectively. INT adherence was 53% (i.e., ≥3 child OHP events, ≥1 caregiver OHP events, and ≥3 fluoride varnish). After 3 y, dmfs increased in both groups (+12.9 INT vs. +10.8 UC; P = 0.216), as did caries prevalence (86.5% to 96.6% INT vs. 90.1% to 98.2% UC; P = 0.808) in a modified intention-to-treat analysis of 897 caregiver-child dyads receiving 1 y of INT. Caregiver oral health knowledge scores improved in both groups (75.1% to 81.2% INT vs. 73.6% to 79.5% UC; P = 0.369). Caregiver oral health behavior scores improved more rapidly in the INT group versus the UC group (P = 0.006). The dmfs increment was smaller among adherent INT children (+8.9) than among UC children (+10.8; P = 0.028) in a per-protocol analysis. In conclusion, the severity of dental disease in Navajo Head Start children is extreme and difficult to improve. The authors argue that successful approaches to prevention may require even more highly personalized approaches shaped by cultural perspectives and attentive to the social determinants of oral health (ClinicalTrials.gov NCT01116739).
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Affiliation(s)
- P A Braun
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D O Quissell
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W G Henderson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - L L Bryant
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S E Gregorich
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - C George
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Toledo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - D Cudeii
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - V Smith
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N Johs
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Cheng
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Rasmussen
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - N F Cheng
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - W Santo
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Batliner
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Wilson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - A Brega
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - R Roan
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - K Lind
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - T Tiwari
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S Shain
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - G Schaffer
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - M Harper
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - S M Manson
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - J Albino
- University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Kim J, Choi Y, Park S, Kim JL, Lee TH, Cho KH, Park EC. Disparities in the experience and treatment of dental caries among children aged 9-18 years: the cross-sectional study of Korean National Health and Nutrition Examination Survey (2012-2013). Int J Equity Health 2016; 15:88. [PMID: 27268237 PMCID: PMC4897910 DOI: 10.1186/s12939-016-0377-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Accepted: 05/30/2016] [Indexed: 10/28/2022] Open
Abstract
BACKGROUND The aim of this study is to examine the association between parental socioeconomic status (SES) and the experience as well as treatment of dental caries among children aged 9 to 18 years. METHODS Data from 1253 children aged 9-18 years from the Korean National Health and Nutrition Examination Survey (2012-2013) were analyzed. Parental socioeconomic status was measured using household income level and maternal educational level. The decayed, missing, and filled teeth (DMFT) index was used to measure experience of dental caries (DMFT ≥ 1). Non-treatment of dental caries was measured according to whether the participants who experienced dental caries used a dental service at a dental clinic to treat caries during the previous year. Logistic regression was used to investigate the association between parental socioeconomic status and the experience of dental caries as well as the association between parental socioeconomic status and the non-treatment of dental caries among children that have experienced caries. RESULTS A total of 808 subjects (64.5 %) experienced dental caries among 1253 participants, and 582 of these 808 subjects (72.0 %) did not receive treatment among those having experience of dental caries. Parental socioeconomic status was not associated with experience of dental caries. However, those from low- and middle-income households were less likely to receive treatment than those from high-income households (odds ratio [OR] 2.11 [95 % confidence interval (CI) 1.16-3.86], OR 2.14 [95 % CI 1.27-3.62]). In particular, those from low- and middle-income households who had regular dental checkups were more likely to have untreated caries than those from high-income households (OR 3.58 [95 % CI 1.25-10.24]). CONCLUSIONS This study demonstrates the parental household income-related disparities in children's dental health treatment. Efforts should be made to lower financial barriers to dental health services, particularly among those from low-income households, in order to reduce dental health disparities in the treatment of caries in children.
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Affiliation(s)
- Juyeong Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Young Choi
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Sohee Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea.,Department of Biostatistics, Graduate School of Public Health, Yonsei University, Seoul, Republic of Korea
| | - Jeong Lim Kim
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Tae-Hoon Lee
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Kyoung Hee Cho
- Department of Public Health, Graduate School, Yonsei University, Seoul, Republic of Korea.,Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea
| | - Eun-Cheol Park
- Institute of Health Services Research, Yonsei University, Seoul, Republic of Korea. .,Department of Preventive Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
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Vernon LT, Jayashantha P, Chidzonga MM, Komesu MC, Nair RG, Johnson NW. Comorbidities associated with HIV and antiretroviral therapy (clinical sciences): a workshop report. Oral Dis 2016; 22 Suppl 1:135-48. [PMID: 27109282 PMCID: PMC5986297 DOI: 10.1111/odi.12412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Revised: 10/23/2015] [Accepted: 10/24/2015] [Indexed: 12/23/2022]
Abstract
In the era of combination antiretroviral therapy (ART), parsing out the effects of HIV vs ART on health outcomes is challenging. Nadir CD4 count, a marker of the extent of immunosuppression, has significant long-term impact on an array of disease states in HIV+ persons; however, in the dental literature, reporting of pre-ART exposure to immunosuppression has largely been ignored and this limits the validity of previous studies. In Workshop A1, we explain fully the importance of nadir CD4, pre-ART immunosuppression, and identify a need to include specific variables in future research. The questions posed herein are challenging, typically not neatly addressed by any one study and require integration of the latest evidence from the wider medical literature. We consider topics beyond the confines of the oral cavity and examine oral health in the complex context of ART era HIV immunopathophysiology. We depict how variability in geographic setting and time period (pre- and post-ART era) can impact oral conditions - influencing when HIV infection was detected (at what CD4 count), the type and timing of ART as well as social determinants such as strong stigma and limited access to care. We hope our Workshop will stir debate and energize a rigorous focus on relevant areas of future research in HIV/AIDS.
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Affiliation(s)
- L T Vernon
- Department of Biological Sciences, Case Western Reserve University School of Dental Medicine, Cleveland, OH, USA
| | - Plp Jayashantha
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Qld, Australia and Dental Hospital, and Sri Lanka Air Force Station Colombo, Sri Lanka, Australia
| | - M M Chidzonga
- College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe
| | - M C Komesu
- Department of Morphology, Stomatology Physiology, University of Sao Paulo, Ribeirao Preto, Sao Paulo, Brazil
| | - R G Nair
- Oral Medicine, School of Dentistry and Oral Health, Griffith University, Gold Coast, Qld, Australia and Cancer Services, Gold Coast University Hospital, Queensland Health, Qld, Autralia, Australia
| | - N W Johnson
- Menzies Health Institute, Griffith University, Gold Coast, Qld, Australia
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81
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de Mello ALSF, de Andrade SR, Moysés SJ, Erdmann AL. [Oral health care in the health network and the regionalization process]. CIENCIA & SAUDE COLETIVA 2016; 19:205-14. [PMID: 24473617 DOI: 10.1590/1413-81232014191.1748] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 09/07/2012] [Indexed: 11/21/2022] Open
Abstract
The scope of this article is to outline the construction of the regionalized health network, focusing on oral health care and identifying the problems and the progress in its implementation. The context was the proposed national network model in the policies that underpin the Unified Health System. This is a descriptive-exploratory study with a qualitative approach methodologically supported by Grounded Theory. Interviews were conducted with managers, health professionals and teachers graduated in Dentistry, forming three sample groups. The core category was named "Enhancing the interaction of oral health care in the health network in the regionalization process." In the proposed theoretical model, the enhancement of interaction arises from conditions such as: the characterization of oral health care in the regionalized health network; the identification of difficulties in the implementation process; and the analysis of the operation of the oral health care network. The inclusion of oral health in the network is at an early stage, sometimes detached from the set of relations that constitutes the health network, which is also being consolidated. Evidence gathered in this study indicates the structuring of the regionalized health care network as a prerequisite to raise oral health care and assistance to a new level.
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82
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Fernandes JDKB, Pinho JRO, Queiroz RCDS, Thomaz EBAF. [Evaluation of oral health indicators in Brazil: a trend towards equity in dental care?]. CAD SAUDE PUBLICA 2016; 32:e00021115. [PMID: 26910254 DOI: 10.1590/0102-311x00021115] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 06/08/2015] [Indexed: 11/22/2022] Open
Abstract
This study tested the hypothesis that oral health indicators from the Pact for Primary Healthcare 2006, the Biennial Pact for Health 2010-2011, and the indicators for the transition from the Pact for Health to the 2012 Organizational Contract for Public Action in Health did not differ between states of Brazil with different Human Development Indices (HDI). A longitudinal ecological study was performed, comparing the states of Brazil with the highest and lowest HDIs. Data were obtained from the information systems of the Brazilian Unified National Health System (SUS) and the United Nations Development Program (UNDP) and submitted to mixed-effects linear regression (alpha = 5%). All the indicators for opportunity of access to oral health care were inversely associated with HDI. For indicators of use, the association only occurred with two indicators. The results showed a trend towards equity for indicators of opportunity of access to oral health.
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83
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Pinto RDS, Roncalli AG, Abreu MHNG, Vargas AMD. Use of Public Oral Health Services by the Adult Population: A Multilevel Analysis. PLoS One 2016; 11:e0145149. [PMID: 26730714 PMCID: PMC4701482 DOI: 10.1371/journal.pone.0145149] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 12/01/2015] [Indexed: 11/18/2022] Open
Abstract
Background It is important to assess context to explain inequalities in oral health, particularly with regard to the type of service used; thus, this study aimed to identify the social determinants of public dental service use by adults and to assess whether, beyond the level individual, existing inequalities are also expressed in the context in which individuals are embedded. Methods A multilevel analysis with three levels of aggregation of variables was performed. The individual variables were derived from the database of the SB Minas Gerais project—a survey of oral health status of the population of Minas Gerais, a state of the Brazilian Southeast region. The variable at the neighborhood level came from the Census of 2010. The variables at the municipal level were obtained from available public databases relating to oral health services. At the municipal level, the Human Development Index (HDI) variable was chosen to represent quality of life in the municipalities. Results In the final model, the following individual variables were associated with greater use of public dental services: lower income (PR = 1.98, 95% CI = 1.53; 2.58), higher number of residents at home (PR = 1.37, 95% CI = 1.11; 1.68) and higher number of teeth requiring treatment (PR = 1.49, 95% CI = 1.20; 1.84). With regard to context variables, a poorer infrastructure (PR = 0.62, 95% CI = 0.40; 0.96) leads to a lower use of public services. Conclusion The use of public services is associated with family income, how this income is divided in households, the need for treatment presented by the individual and the organization of the existing oral health service infrastructure in the municipality.
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Affiliation(s)
- Rafaela da Silveira Pinto
- Oral Health Department of Minas Gerais, Minas Gerais State Health Department, Belo Horizonte, Minas Gerais, Brazil
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil., Belo Horizonte, Minas Gerais, Brazil
- * E-mail:
| | - Angelo Giuseppe Roncalli
- Department of Dentistry, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
| | | | - Andréa Maria Duarte Vargas
- Department of Community and Preventive Dentistry, School of Dentistry, Universidade Federal de Minas Gerais, Brazil., Belo Horizonte, Minas Gerais, Brazil
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Wallace B, Browne AJ, Varcoe C, Ford-Gilboe M, Wathen N, Long PM, Parker J. Self-reported oral health among a community sample of people experiencing social and health inequities: cross-sectional findings from a study to enhance equity in primary healthcare settings. BMJ Open 2015; 5:e009519. [PMID: 26700285 PMCID: PMC4691735 DOI: 10.1136/bmjopen-2015-009519] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 09/30/2015] [Accepted: 10/16/2015] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To describe the self-reported oral health issues among a community sample of primary care clients experiencing socioeconomic disadvantages. METHODS As part of a larger mixed-methods, multiple case study evaluating an equity-oriented primary healthcare intervention, we examined the oral health of a sample of 567 people receiving care at four clinics that serve marginalised populations in two Canadian provinces. Data collected included self-rated oral health and experiences accessing and receiving healthcare, standard self-report measures of health and quality of life, and sociodemographic information. RESULTS The prevalence of self-rated poor oral health was high, with almost half (46.3%) of the participants reporting poor or fair oral health. Significant relationships were observed between poor oral health and vulnerabilities related to mental health, trauma and housing instability. Our findings suggest that the oral health of some Canadian populations may be dramatically worse than what is reported in existing population health surveys. CONCLUSIONS Our findings reinforce the importance of addressing oral health as part of health equity strategies. The health and oral health issues experienced by this client cohort highlight the need for interdisciplinary, team-based care that can address the intersections among people's health status, oral health and social issues.
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Affiliation(s)
- Bruce Wallace
- School of Social Work, University of Victoria, Victoria, British Columbia, Canada
| | - Annette J Browne
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Colleen Varcoe
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marilyn Ford-Gilboe
- Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada
| | - Nadine Wathen
- Faculty of Information & Media Studies, Western University, London, Ontario, Canada
| | - Phoebe M Long
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joanne Parker
- School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
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Afuakwah C, Welbury R. WHY DO YOU NEED TO USE A CARIES RISK ASSESSMENT PROTOCOL TO PROVIDE AN EFFECTIVE CARIES PREVENTIVE REGIME? Prim Dent J 2015; 4:56-66. [PMID: 26966775 DOI: 10.1308/205016815816682155] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
BACKGROUND Clinical guidelines recommend an individual is given a caries risk status based on analysis of defined clinical and social criteria before implementing a tailored preventive plan. AIMS Improve documentation of caries risk assessment (CRA) in a general dental practice setting, using a systems-based approach to quality improvement methods. Investigate the impact of quality improvement efforts on subsequent design and delivery of preventive care. Identify barriers to delivery of CRA and provision of preventive care. DESIGN Data for patients aged 0-16 years was collected over two cycles using standard audit methodology. The first cycle was a retrospective analysis (n = 400) using random sampling. The second cycle a prospective analysis (n = 513) using consecutive sampling over a 15-week period. Five staff meetings with feedback occurred between cycles. RESULTS In cycle one, no specific CRA system was identified. CRA status was not stated widely, risk factors were not analysed and there was variation with respect to the prescription and delivery of preventive strategies. These discrepancies were demonstrable for all four participating dentists and at all ages. In cycle two, 100% recorded CRA. All risk factors were analysed and individual caries risk was correctly annotated. There was 100% compliance with the protocol for preventive plans. CONCLUSIONS The use of CRA improved documentation of caries risk status. This has improved subsequent prescription of age specific evidence-based preventive care appropriate to the risk status of that individual. Barriers were identified to the delivery of CRA and the provision of comprehensive preventive care by the dentists and other healthcare professionals.
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86
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Kramer PF, Chaffee BW, Bertelli AE, Ferreira SH, Béria JU, Feldens CA. Gains in children's dental health differ by socioeconomic position: evidence of widening inequalities in southern Brazil. Int J Paediatr Dent 2015; 25:383-92. [PMID: 25323949 PMCID: PMC4401627 DOI: 10.1111/ipd.12140] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
UNLABELLED Oral health inequalities are the measures by which equity in oral health is tracked. Despite widespread improvement in children's dental health globally, substantial socio-economic disparities persist and may be worsening. OBJECTIVES Quantify 10-year changes in child caries occurrence by socio-economic position in a Southern Brazilian city and compare oral health inequalities over time. METHODS Representative surveys of dental caries in children (age <6 years) in Canoas, Brazil, were conducted in 2000 and 2010 following standardized methods. For each survey year, we calculated disparities by socio-economic position (maternal education and family income) in age- and sex-standardized caries occurrence (prevalence: dmft > 0; severity: mean dmft) using absolute measures (difference and Slope Index of Inequality) and relative measures (ratio and Relative Index of Inequality). RESULTS Comparing 2010 to 2000, caries occurrence was lower in all socio-economic strata. However, reductions were more pronounced among socio-economically advantaged groups, yielding no improvement in children's oral health disparities. Some disparity indicators were consistent with increasing inequality. CONCLUSIONS Overall, dental caries levels among children in Canoas improved, but inequalities in disease distribution endured. Concerted public health efforts targeting socio-economically disadvantaged groups are needed to achieve greater equity in children's oral health.
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Affiliation(s)
| | - Benjamin W. Chaffee
- Department of Preventive and Restorative Dental Sciences, University of California San Francisco, San Francisco, United States
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Yang SE, Park YG, Han K, Min JA, Kim SY. Dental pain related to quality of life and mental health in South Korean adults. PSYCHOL HEALTH MED 2015; 21:981-92. [PMID: 26456324 DOI: 10.1080/13548506.2015.1098781] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
High levels of stress, anxiety and depression have been reported in patients with orofacial pain. Dental pain has the potential to reduce quality of life (QOL), and pain relief is important aspect of QOL. The purpose of this study was to assess the relationships of dental pain with QOL and mental health using a nationally representative, population-based study. This study analyzed data from the 2012 Korea National Health and Nutrition Examination Survey (N = 5469). Oral health status was assessed using the oral health questionnaire, and oral examination was performed by trained dentists. Health-related QOL (HRQOL) was evaluated using EQ-5D and EQ-VAS, and mental health was evaluated by questionnaires. Logistic regression was applied to estimate adjusted odds ratios (AOR) and 95% confidence intervals (CI). Among 5469 adults, 1992 (36.42%) presented self-reported dental pain. Participants with anxiety/depression or pain/discomfort, and participants with stress, melancholy, suicidal thought or depression showed significantly higher prevalence of dental pain. After adjusting for covariates, five aspects of QOL and five aspects of mental health were related with dental pain. The AORs (95% CI) for dental pain were 1.39 (1.06-1.81) for mobility, 1.77 (1.19-2.63) for self-care, 1.38 (1.02-1.85) for usual activities, 1.73 (1.43-2.09) for pain/discomfort and 1.50 (1.13-1.98) for anxiety/depression. For mental health status factors, the AORs (95% CI) for dental pain were 1.29 (1.11-1.51) for stress, 1.37 (1.09-1.74) for melancholy, 1.26 (1.01-1.58) for suicidal thoughts, 1.43 (.93-2.19) for consultation to psychiatrist and 1.53 (1.07-2.19) for depression. This study showed that dental pain has an association with lower HRQOL and worse mental health status in South Korean adults.
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Affiliation(s)
- Sung-Eun Yang
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Yong-Gyu Park
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Kyungdo Han
- b Department of Biostatistics , College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Jung-Ah Min
- c Department of Psychiatry , Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
| | - Sin-Young Kim
- a Department of Conservative Dentistry , Seoul St. Mary's Dental Hospital, College of Medicine, The Catholic University of Korea , Seoul , Republic of Korea
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Fernández MR, Goettems ML, Ardenghi TM, Demarco FF, Correa MB. The Role of School Social Environment on Dental Caries Experience in 8- to 12-Year-Old Brazilian Children: A Multilevel Analysis. Caries Res 2015; 49:548-56. [DOI: 10.1159/000438832] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/17/2015] [Indexed: 11/19/2022] Open
Abstract
Aim: Although children spend most of their time involved in activities related to school, few studies have focused on the association between school social environment and oral health. This cross-sectional study assessed individual and school-related social environment correlates of dental caries in Brazilian schoolchildren aged 8-12 years. Methods: A sample of children from 20 private and public schools (n = 1,211) was selected. Socio-economic data were collected from parents, and data regarding children characteristics were collected from children using a questionnaire. Dental examinations were performed to assess the presence of dental plaque: dental caries experience (DMFT ≥1) and dental caries severity (mean dmf-t/DMF-T). The social school environment was assessed by a questionnaire administered to school coordinators. Multilevel Poisson regression was used to investigate the association between school social environment and dental caries prevalence and experience. Results: The dental caries prevalence was 32.4% (95% confidence interval: 29.7-35.2) and the mean dmf-t/DMF-T was 1.84 (standard deviation: 2.2). Multilevel models showed that the mean dmf-t/DMF-T and DMFT ≥1 were associated with lower maternal schooling and higher levels of dental plaque. For contextual variables, schools offering after-hours sports activities were associated with a lower prevalence of dental caries and a lower mean of dmf-t/DMF-T, while the occurrence of violence and theft episodes was positively associated with dental caries. Conclusions: The school social environment has an influence on dental caries in children. The results suggest that strategies focused on the promotion of healthier environments should be stimulated to reduce inequalities in dental caries.
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89
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Álvarez L, Liberman J, Abreu S, Mangarelli C, Correa MB, Demarco FF, Lorenzo S, Nascimento GG. Dental caries in Uruguayan adults and elders: findings from the first Uruguayan National Oral Health Survey. CAD SAUDE PUBLICA 2015; 31:1663-72. [DOI: 10.1590/0102-311x00132214] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
This study aimed to assess dental caries status and associated factors in Uruguayan adults and elders using data from the first Uruguayan National Oral Health Survey. Data were representative of the country as a whole. Socio-demographic information was collected with a closed questionnaire. Dental caries was assessed by clinical examination using the DMFT index. The final sample consisted of 769 participants. Mean DMFT was 15.20 and 24.12 for the 35-44 and 65-74-year age groups, respectively. Mean number of decayed teeth was 1.70 in adults and 0.66 in elders. Multivariate analyses showed higher prevalence of dental caries associated with age 65-74 years, low socioeconomic status, use of public dental services, presence of gingivitis; for decayed teeth, age 35-44 years, low socioeconomic status, use of public dental services, infrequent tooth brushing, need for oral health care, and presence of root caries showed higher severity. Uruguayan adults and elders from disadvantaged backgrounds concentrated a heavier burden of dental caries.
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90
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Gabardo MCL, Moysés SJ, Moysés ST, Olandoski M, Olinto MTA, Pattussi MP. Social, economic, and behavioral variables associated with oral health-related quality of life among Brazilian adults. CIENCIA & SAUDE COLETIVA 2015; 20:1531-40. [DOI: 10.1590/1413-81232015205.13562014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2014] [Accepted: 09/14/2014] [Indexed: 11/22/2022] Open
Abstract
The aim of this study was to investigate the association between sociodemographic, socioeconomic, psychosocial, and behavioral variables and oral health as assessed using the 14-question short version of the Oral Health Impact Profile (OHIP-14). A cross-sectional study was performed with 1095 adult residents from 38 census tracts in the municipality of São Leopoldo, State of Rio Grande do Sul, Brazil. Responses to the OHIP-14 were dichotomized, and bivariate (Chi-square) and multivariate analysis (logistic regression and Wald's test) were performed. In the bivariate analysis, the worse effects were reported by female individuals, the elderly, those with low family income, less schooling, those reporting a lower quality of life and social support, and smokers. In the multivariate analysis the following variables maintained their statistical significance: gender (female), age (50-59 years), family income (low), quality of life (low), social support (low, moderate), and smoking (smokers). Individuals' self-perception of their oral health was related to sociodemographic, socioeconomic, psychosocial, and behavioral variables, thus confirming that emphasis should be placed on social factors when addressing oral health problems.
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91
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Mehta VV, Rajesh G, Rao A, Shenoy R, Pai M. Social determinants of health and oral health: An Indian perspective. Indian J Occup Environ Med 2015; 19:71-5. [PMID: 26500407 PMCID: PMC4596073 DOI: 10.4103/0019-5278.165335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Several conventional approaches have been tried in the past to resolve health inequities in India. However, achieving Universal Health Coverage (UHC) is yet to be fully realized as the benefits have been meager. The recent concept of targeting social determinants of general and oral health in order to achieve health for all has shown positive results in the developed as well as the developing nations. Based on the framework recommended by the Commission on Social Determinants of Health, several policies have been introduced and suitably backed up with the intention of providing health care even to people living in remote sections of the society. This paper intends to highlight the rationale for social determinants approach in Indian context, its application and future recommendations for the same. It is considered as a radical approach, and adequate measures have been implemented by health systems to achieve the desired targets without delay. However, in order to achieve UHC, redistribution of the available resources and converting the "normative" needs into "felt" needs of the people is going to be an uphill task to accomplish.
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Affiliation(s)
- Viral V. Mehta
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - G. Rajesh
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Ashwini Rao
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Ramya Shenoy
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
| | - Mithun Pai
- Department of Public Health Dentistry, Manipal College of Dental Sciences, Manipal University, Mangalore, Karnataka, India
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92
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de Araujo Neris M, Cortelli SC, Aquino DR, de Miranda TB, Costa FDO, Cortelli JR. A. actinomycetemcomitans profile and red complex bacterial species of an Afro-Brazilian community: A comparative study. Arch Oral Biol 2015; 60:753-9. [DOI: 10.1016/j.archoralbio.2015.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Revised: 11/18/2014] [Accepted: 01/31/2015] [Indexed: 11/29/2022]
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93
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Blair YI, McMahon AD, Gnich W, Conway DI, Macpherson LMD. Elimination of 'the Glasgow effect' in levels of dental caries in Scotland's five-year-old children: 10 cross-sectional surveys (1994-2012). BMC Public Health 2015; 15:212. [PMID: 25879616 PMCID: PMC4352263 DOI: 10.1186/s12889-015-1492-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 01/29/2015] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Socioeconomic inequalities in health within Glasgow, Scotland, are among the widest in the world. This is largely attributed to socio-economic conditions. The 'Glasgow Effect' labels the finding that the high prevalence of some diseases cannot be fully explained by a conventional area-based socio-economic metric. This study aimed to investigate whether differences in dental caries between Glasgow's resident children and those in the Rest of Scotland could be explained by this metric and whether differences were of fixed magnitude, over time. METHODS Scotland's National Dental Inspection Programme (NDIP) cross-sectional data for five-year-old children in years: 1994, 1996, 1998, 2000, 2003, 2004, 2006, 2008, 2010, and 2012 (n = 92,564) were utilised. Endpoints were calculated from the mean decayed, missing and filled teeth score (d3mft) and percentage with obvious decay experience. Socioeconomic status was measured by DepCat, a Scottish area-based index. The Glasgow Effect was estimated by the odds-ratio (OR) of decay for Glasgow versus the Rest of Scotland adjusted by age, gender and DepCat. Inequalities were also assessed by the Significant Caries Index (SIC), SIC 10, and Scottish Caries Inequality Metric (SCIM 10). RESULTS Decay levels for deprived Glasgow children have reduced to be similar to those in the Rest of Scotland. In 1993, OR for d3mft > 0 for those living in the Glasgow area was 1.34(1.10, 1.64), p = 0.005. This reduced below unity in 2012, OR = 0.85(0.77, 0.93), p < 0.001. There were downward trends (p < 0.001) in absolute inequality measured by SIC and SIC 10 in each of the geographic areas. The SCIM 10 demonstrated further reductions in inequality across the population. The downward trends for all the inequality measures were larger for Glasgow than the Rest of Scotland. CONCLUSIONS Over the interval, Glasgow has eliminated the earlier extra health inequalities. When comparing 'like for like' by socioeconomic status there is now no higher level of dental caries in the Greater Glasgow area.
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Affiliation(s)
- Yvonne I Blair
- Oral Health Directorate, NHS Greater Glasgow & Clyde, Glasgow Dental Hospital, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Alex D McMahon
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Wendy Gnich
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - David I Conway
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
| | - Lorna M D Macpherson
- Community Oral Health Section, University of Glasgow Dental School, 378 Sauchiehall St, Glasgow, G2 3JZ, Scotland, UK.
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94
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Roncalli AG, Sheiham A, Tsakos G, Watt RG. Socially unequal improvements in dental caries levels in Brazilian adolescents between 2003 and 2010. Community Dent Oral Epidemiol 2015; 43:317-24. [DOI: 10.1111/cdoe.12156] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 01/13/2015] [Indexed: 01/28/2023]
Affiliation(s)
- Angelo G. Roncalli
- Department of Dentistry; Federal University of Rio Grande do Norte; Natal RN Brazil
- Department of Epidemiology and Public Health; University College London; London UK
| | - Aubrey Sheiham
- Department of Epidemiology and Public Health; University College London; London UK
| | - Georgios Tsakos
- Department of Epidemiology and Public Health; University College London; London UK
| | - Richard G. Watt
- Department of Epidemiology and Public Health; University College London; London UK
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95
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Oral Health Over the Life Course. A LIFE COURSE PERSPECTIVE ON HEALTH TRAJECTORIES AND TRANSITIONS 2015. [DOI: 10.1007/978-3-319-20484-0_3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
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96
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Reis CM, Rodriguez C, Macaulay AC, Bedos C. Dental Students’ Perceptions of and Attitudes About Poverty: A Canadian Participatory Case Study. J Dent Educ 2014. [DOI: 10.1002/j.0022-0337.2014.78.12.tb05838.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Clarice M.R. Reis
- Department of Community and Preventive Dentistry; Federal University of Minas Gerais; Minas Gerais; Brazil
| | - Charo Rodriguez
- Department of Family Medicine; McGill University; Montreal; Quebec Canada
| | - Ann C. Macaulay
- Department of Family Medicine; McGill University; Montreal; Quebec Canada
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Batista MJ, Lawrence HP, de Sousa MDLR. Impact of tooth loss related to number and position on oral health quality of life among adults. Health Qual Life Outcomes 2014; 12:165. [PMID: 25433483 PMCID: PMC4263115 DOI: 10.1186/s12955-014-0165-5] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 11/04/2014] [Indexed: 11/17/2022] Open
Abstract
Background The objective of this study was to evaluate the impact of tooth loss on oral health-related quality of life (OHRQoL) in adults with emphasis on the number of teeth lost and their relative position in the mouth. Methods The study population was a cross-sectional household probability sample of 248, representing 149,635 20–64 year-old residents in Piracicaba-SP, Brazil. OHRQoL was measured using the OHIP-14. Socioeconomic, demographic, health literacy, dental services use data and clinical variables were collected. Oral examinations were performed using WHO criteria for caries diagnosis, using the DMFT index; that is, the sum of decayed, missing and filled teeth (DMFT). An ordinal scale for tooth loss, based on position and number of missing teeth, was the main explanatory variable. The total OHIP score was the outcome for negative binomial regression and OHIP prevalence was the outcome for logistic regression at 5% level. A hierarchical modeling approach was adopted according to conceptual model. Results OHIP score was 10.21 (SE 1.16) with 48.1% (n=115) reporting one or more impacts fairly/very often (OHIP prevalence). Significant prevalence rate ratios (PRRs) for OHIP severity were observed for those who had lost up to 12 teeth, including one or more anterior teeth (PRR=1.63, 95%CI 1.06–2.51), those who had lost 13–31 teeth (PRR=2.33, 95%CI 1.49–3.63), and the edentulous (PRR=2.66, 95%CI 1.55–4.57) compared with fully dentate adults. Other significant indicators included those who only sought dental care because of dental pain (PRR=1.67, 95%CI 1.11–2.51) or dental needs (PRR=1.84, 95%CI 1.24–2.71) and having untreated caries (PRR=1.57 95%CI 1.09–2.26). Tooth loss was not significantly associated with OHIP prevalence; instead using dental services due to dental pain (PR=2.43, 95%CI 1.01–5.82), having untreated caries (PR=3.96, 95%CI 1.85–8.51) and low income (PR=2.80, 95%CI 1.26–6.42) were significant risk indicators for reporting OHIP prevalence. Conclusion Our analyses showed OHRQoL gradients consistent with the number and position of teeth missing due to oral disease. These findings suggest that the quantity of teeth lost does not necessarily reflect the impact of tooth mortality on OHRQoL and that future studies should take this into consideration.
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Affiliation(s)
- Marília Jesus Batista
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Avenida Limeira, 901, P.O. Box 52, Piracicaba, 13414-018, SP, Brazil.
| | - Herenia Procopio Lawrence
- Dental Public Health Discipline, Faculty of Dentistry, University of Toronto, Canada, 124 Edward Street, Toronto, M5G 1G6, Ontario, Canada.
| | - Maria da Luz Rosário de Sousa
- Department of Community Dentistry, Piracicaba Dental School, University of Campinas, Avenida Limeira, 901, P.O. Box 52, Piracicaba, 13414-018, SP, Brazil.
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98
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Moysés SJ, Pucca Junior GA, Paludetto Junior M, Moura LD. [Progresses and challenges to the Oral Health Surveillance Policy in Brazil]. Rev Saude Publica 2014; 47 Suppl 3:161-7. [PMID: 24626593 DOI: 10.1590/s0034-8910.2013047004329] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Accepted: 08/25/2012] [Indexed: 11/21/2022] Open
Abstract
This comprehensive critical review, carried out in a descriptive-discursive style, presents the oral health surveillance policy currently in force in Brazil. Based on an appraisal of the national and international literature on the subject of health surveillance, it examines the formulation of a scientific and political agenda for oral health surveillance, which is anchored in the institutions of the Brazilian Public Health System. The accomplishment of this agenda is exemplified by the presentation of the most recent Brazilian Oral Health survey (SBBrasil 2010). A conclusive summary is presented on the search for a theoretical and methodological convergence of both the identification of the obstacles and weaknesses still detectable in this policy, and the recognition of its virtues already confirmed by important advances and achievements.
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99
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Ardenghi TM, Piovesan C, Antunes JLF. [Inequalities in untreated dental caries prevalence in preschool children in Brazil]. Rev Saude Publica 2014; 47 Suppl 3:129-37. [PMID: 24626589 DOI: 10.1590/s0034-8910.2013047004352] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2012] [Accepted: 03/20/2013] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To evaluate the influence of social inequalities of individual and contextual nature on untreated dental caries in Brazilian children. METHODS The data on the prevalence of dental caries were obtained from the Brazilian Oral Health Survey (SBBrasil 2010) Project, an epidemiological survey of oral health with a representative sample for the country and each of the geographical micro-regions. Children aged five (n = 7,217) in 177 municipalities were examined and their parents/guardians completed a questionnaire. Contextual characteristics referring to the municipalities in 2010 (mean income, fluorodized water and proportion of residences with water supply) were supplied by the Fundação Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). Multilevel Poisson regression analysis models were used to assess associations. RESULTS The prevalence of non-treated dental caries was 48.2%; more than half of the sample had at least one deciduous tooth affected by dental caries. The index of dental caries in deciduous teeth was 2.41, with higher figures in the North and Northeast. Black and brown children and those from lower income families had a higher prevalence of untreated dental caries. With regards context, the mean income in the municipality and the addition of fluoride to the water supply were inversely associated with the prevalence of the outcome. CONCLUSIONS Inequalities in the prevalence of untreated dental caries remain, affecting deciduous teeth of children in Brazil. Planning public policies to promote oral health should consider the effect of contextual factors as a determinant of individual risk.
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100
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Guessous I, Theler JM, Durosier Izart C, Stringhini S, Bodenmann P, Gaspoz JM, Wolff H. Forgoing dental care for economic reasons in Switzerland: a six-year cross-sectional population-based study. BMC Oral Health 2014; 14:121. [PMID: 25270828 PMCID: PMC4190381 DOI: 10.1186/1472-6831-14-121] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Accepted: 09/25/2014] [Indexed: 11/25/2022] Open
Abstract
Background While oral health is part of general health and well-being, oral health disparities nevertheless persist. Potential mechanisms include socioeconomic factors that may influence access to dental care in the absence of universal dental care insurance coverage. We investigated the evolution, prevalence and determinants (including socioeconomic) of forgoing of dental care for economic reasons in a Swiss region, over the course of six years. Methods Repeated population-based surveys (2007–2012) of a representative sample of the adult population of the Canton of Geneva, Switzerland. Forgone dental care, socioeconomic and insurance status, marital status, and presence of dependent children were assessed using standardized methods. Results A total of 4313 subjects were included, 10.6% (457/4313) of whom reported having forgone dental care for economic reasons in the previous 12 months. The crude percentage varied from 2.4% in the wealthiest group (monthly income ≥13,000CHF, 1CHF ≈ 1$) to 23.5% among participants with the lowest income (<3,000CHF). Since 2007/8, forgoing dental care remained stable overall, but in subjects with a monthly income of <3,000CHF, the adjusted percentage increased from 16.3% in 2007/8 to 20.6% in 2012 (P trend = 0.002). Forgoing dental care for economic reasons was independently associated with lower income, younger age, female gender, current smoking, having dependent children, divorced status and not living with a partner, not having a supplementary health insurance, and receipt of a health insurance premium cost-subsidy. Conclusions In a Swiss region without universal dental care insurance coverage, prevalence of forgoing dental care for economic reasons was high and highly dependent on income. Efforts should be made to prevent high-risk populations from forgoing dental care. Electronic supplementary material The online version of this article (doi:10.1186/1472-6831-14-121) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Idris Guessous
- Division of Primary Care Medicine, Department of Community Medicine, Primary Care and Emergency Medicine, University Hospitals of Geneva and Faculty of Medicine, University of Geneva, Geneva, Switzerland.
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